The Complementary Iceberg Tips of Diabetes and Precision Medicine.

Diabetes is perceived as a “simple disease” and manifested in the form of inadequate blood glucose regulation. Paradoxically, it is now also recognized as a global, pandemic disease, with ~415 million patients reported to be suffering from diabetes. The disease is projected to impact ~642 million people worldwide by 2040. This appears to be the tip of a diabetic iceberg, since one-in-two adults are actually undiagnosed diabetics, an additional ~318 million people have impaired glucose tolerance, and are usually described as “pre-diabetic,” and 20-25 % of adults have metabolic syndrome. The limitations of modern healthcare have been ascribed as causative agents in the diabetes crisis. The current healthcare system tends to provide a reactive response to patient symptoms, with a subsequent diagnosis and corresponding treatment of the specific disease. More recently a rapid improvement in OMIC analyses, bioinformatics and knowledge management tools, as well as the emergence of big data analytics, and systems biology have led to a better understanding of the profound, dynamic complexity and variability of individuals and human populations as they undertake their daily activities. These developments in conjunction with escalating healthcare costs and relatively poor disease treatment efficacies have fermented a rethink in how we execute current medical practice. This has led to the emergence of “P-Medicine” which includes personalized and precision medicine. P-medicine is still in a fledgling and evolutionary phase and there has been considerable debate over its current status and future trajectory, as well as its ability to affect the runaway crises of pandemic diabetes. Some have argued that as personalized medicine has morphed into precision medicine (PM) we are just realizing the tip of the PM iceberg. In this paper we evaluate such claims and address the impact of PM on the diagnosis, treatment and prognosis of diabetes and the complementary of the diabetic iceberg tip of despair and the PM iceberg tip of potential and hope.